Sign up to receive free email alerts when patent applications with chosen keywords are publishedSIGN UP

Abstract:

A bone fusion device for insertion between bones that are to be fused
together, such as, for example, the vertebrae of a spinal column. The
bone fusion device comprises at least one extendable tab and one or more
tab extension assemblies. Each tab extension assembly is able to be
adjusted in order to individually control the extension or contraction of
a side of the tab thereby enabling adjustment of the height and/or angle
of the tab with respect to the body of the bone fusion device. Each tab
extension assembly is able to be individually adjusted such that the side
controlled by each assembly is raised or lowered until the desired tab
angle is achieved. The tab is advantageously positioned and angled to
correspond to the vertebrae to help brace the device until the bone has
fused.

Claims:

1. A bone fusion device for insertion into a desired location comprising:
a body having an interior cavity; a tab configured to fit within the
interior cavity and selectively move from a retracted position within
interior cavity of the body to an extended position extending out of the
body; and a plurality of extension assemblies coupled to a different
portion of the tab and configured to move the different portions of the
tab between the retracted position and the extended position independent
of the remainder of the extension assemblies.

2. The device of claim 1, wherein each of the extension assemblies
comprise a worm gear operably coupled between a drive screw and a support
jack such that rotation of the drive screw rotates the worm gear which
retracts or extends the support jack into or out of the worm gear.

3. The device of claim 2, wherein at least one of the drive screws of the
extension assemblies is accessible through a first lateral side of the
body and at least a second one of the drive screws is accessible through
a second lateral side of the body.

4. The device of claim 1, wherein the extension assemblies are pivotably
coupled to the different portions of the tab such that the tab is able to
pivot about the extension assembly.

5. The device of claim 1, wherein the body has a bottom surface and an
upper surface, wherein the upper surface is angled with respect to the
bottom surface.

6. The device of claim 1, further comprising one or more plugs, wherein
the body and the tab comprise one or more holes that extend from outside
the device to the inner cavity and are configured to be removably filled
by the plugs.

7. The device of claim 6, wherein the plugs comprise bone material.

8. The device of claim 1, wherein the tab comprises one or more tangs
positioned along the perimeter of the top surface of the tab and fit
within recesses in the top surface of the body when the tab is in the
retracted position.

9. The device of claim 8, wherein one or more of the tangs extend from
the perimeter of the tab to the perimeter of the body.

10. The device of claim 2, further comprising a support webbing
positioned within the inner cavity of the body between one or more walls
of the inner cavity and the exterior of the worm gears such that the
support webbing resists lateral movement of the worm gears with respect
to the walls of the inner cavity.

11. A method of implanting a bone fusion device into a desired location,
the method comprising: inserting the bone fusion device in the desired
location, wherein the bone fusion device comprises a body having an
interior cavity, a tab configured to fit within the interior cavity and
selectively move from a retracted position within interior cavity of the
body to an extended position extending out of the body and a plurality of
extension assemblies coupled to a different portion of the tab and
configured to move the different portions of the tab between the
retracted position and the extended position independent of the remainder
of the extension assemblies; and independently extending one or more of
the different portions of the tab from the retracted position within the
interior cavity to a position at least partially outside the interior
cavity by moving at least one of the extension assemblies.

12. The method of claim 11, further comprising adjusting the amount which
one or more of the different portions of the tab are extended compared to
the remainder of the different portions of the tab such that the angle of
the tab with respect to the body is adjusted.

13. The method of claim 11, wherein each of the extension assemblies
comprise a worm gear operably coupled between a drive screw and a support
jack such that rotation of the drive screw rotates the worm gear which
retracts or extends the support jack into or out of the worm gear.

14. The method of claim 13, wherein at least one of the drive screws of
the extension assemblies is accessible through a first lateral side of
the body and at least a second one of the drive screws is accessible
through a second lateral side of the body.

15. The method of claim 11, wherein the extension assemblies are
pivotably coupled to the different portions of the tab such that the tab
is able to pivot about the extension assembly.

16. The method of claim 11, wherein the body has a bottom surface and an
upper surface, wherein the upper surface is angled with respect to the
bottom surface.

17. The method of claim 11, further comprising removably filling one or
more holes with one or more plugs, wherein the body and the tab comprise
the one or more holes, which extend from outside the device to the inner
cavity and are configured to be removably filled by the plugs.

18. The method of claim 17, wherein the plugs comprise bone material.

19. The method of claim 11, wherein the tab comprises one or more tangs
positioned along the perimeter of the top surface of the tab and fit
within recesses in the top surface of the body when the tab is in the
retracted position.

20. The method of claim 19, wherein one or more of the tangs extend from
the perimeter of the tab to the perimeter of the body.

21. The method of claim 13, wherein the device further comprises a
support webbing positioned within the inner cavity of the body between
one or more walls of the inner cavity and the exterior of the worm gears
such that the support webbing resists lateral movement of the worm gears
with respect to the walls of the inner cavity.

22. The method of claim 11, further comprising retracting the tab of the
bone fusion device into the retracted position before inserting the bone
fusion device into the desired location.

23. A distraction instrument for use with a bone fusion device, the
distraction instrument comprising: a tubular body; a control rod
positioned at least partially within the tubular body, wherein the
control rod comprises a first end coupled with a handle and extending out
a first side of the tubular body and a second end including an engaging
element and extending out a second side of the tubular body; and a head
assembly comprising a plurality of plates and operably coupled with
engaging element of the control rod such that manipulating the control
rod with respect to the head assembly causes the plates to separate.

24. The instrument of claim 23, wherein the head assembly is operably
coupled with the engaging element such that rotation of the control rod
with respect to the head assembly causes the plates to separate and
rotation in the opposite direction causes the plates to contract.

25. The instrument of claim 24, wherein the head assembly further
comprises a jack mechanism coupled between the plates that effectuates
the separating and the contracting of the plates and is configured to fit
within one or more recesses within the plates when the plates are fully
contracted.

26. The instrument of claim 23, further comprising an indicator
positioned on the surface of the instrument, wherein the indicator
dynamically indicates the distance between the plates.

27. The instrument of claim 26, wherein the indicator indicates one or
more values corresponding to how much one or more controls of one or more
bone fusion implant devices must be rotated to extend one or more tabs of
the devices such that the devices have height equal to the distance
between the plates.

28. The instrument of claim 26, further comprising a force sensor coupled
to the head assembly, wherein the force sensor measures a level of force
resisting the separation of the plates.

29. The instrument of claim 28, wherein the indicator indicates the level
of force measured by the force sensor.

30. The instrument of claim 28, wherein the head assembly is configured
to stop the plates from further separating once the level of force
measured by the force sensor equals a threshold level.

31. The instrument of claim 23, further comprising a motor and a motor
control coupled with the control rod, wherein the motor control controls
the operation of the motor and the motor enables motorized manipulation
of the control rod to separate the plates.

32. A method of using a distraction instrument to measure the amount of
space in a desired location, the method comprising: inserting the
distraction instrument in the desired location, wherein the distraction
instrument comprises a tubular body, a control rod positioned at least
partially within the tubular body, wherein the control rod comprises a
first end coupled with a handle and extending out a first side of the
tubular body and a second end including an engaging element and extending
out a second side of the tubular body and a head assembly comprising a
plurality of plates and operably coupled with engaging element of the
control rod such that moving the control rod with respect to the head
assembly causes the plates to separate; and separating the plates until
the plates reach bounds of the desired location by manipulating the
control rod with respect to the head assembly.

33. The method of claim 32, wherein the manipulating the control rod
comprises rotating the control rod with respect to the head assembly
wherein rotation in a first direction causes the plates to separate and
rotation in a second direction causes the plates to contract.

34. The method of claim 32, wherein the head assembly further comprises a
jack mechanism coupled between the plates that effectuates the separating
and the contracting of the plates and is configured to fit within one or
more recesses within the plates when the plates are fully contracted.

35. The method of claim 32, wherein the instrument further comprises an
indicator positioned on the surface of the instrument, wherein the
indicator dynamically indicates the distance between the plates.

36. The method of claim 35, wherein the indicator indicates one or more
values corresponding to how much one or more controls of one or more bone
fusion implant devices must be rotated to extend one or more tabs of the
devices such that the devices have height equal to the distance between
the plates.

37. The method of claim 35, wherein the instrument further comprises a
force sensor coupled to the head assembly, wherein the force sensor
measures a level of force resisting the separation of the plates.

38. The method of claim 37, wherein the indicator indicates the level of
force measured by the force sensor.

39. The method of claim 37, wherein the head assembly is configured to
stop the plates from further separating once the level of force measured
by the force sensor equals a threshold level.

40. The method of claim 32, wherein the instrument further comprises a
motor and a motor control coupled with the control rod, wherein the motor
control controls the operation of the motor and the motor enables
motorized manipulation of the control rod to separate the plates.

41. A bone fusion device for insertion into a desired location
comprising: a body having an interior cavity; a tab configured to fit
within the interior cavity and selectively move from a retracted position
within interior cavity of the body to an extended position extending out
of the body; a plurality of extension assemblies coupled to a different
portion of the tab and configured to move the tab between the retracted
position and the extended position; and a position locking mechanism
operably coupled with each of the plurality of extension assemblies and
configured to provide a plurality of locking positions that the plurality
of extension assemblies are biased to stay in by the position locking
mechanism.

42. The device of claim 41, wherein the plurality of extension assemblies
are configured to move the different portions of the tab between the
retracted position and the extended position independent of the remainder
of the extension assemblies.

43. The device of claim 42, wherein the position locking mechanism
comprises a dial operably coupled with one of the plurality of extension
assemblies such that when the one of the plurality of extension
assemblies is rotated the dial is also rotated.

44. The device of claim 43, wherein the position locking mechanism
comprises one or more stops operably coupled with the dial such that when
the one of the plurality of extension assemblies is in one of the locking
positions the interface between the dial and the stops provides a biasing
force that resists the movement of the one of the plurality of extension
assemblies out of the one of the locking positions.

[0002] This invention relates generally to bone fusion devices. More
specifically, the present invention relates to devices for fusing
vertebrae of the spine that can be inserted arthroscopically.

BACKGROUND OF THE INVENTION

[0003] The spinal column is made up of vertebrae stacked on top of one
another. Between the vertebrae are discs which are gel-like cushions that
act as shock-absorbers and keep the spine flexible. Injury, disease, or
excessive pressure on the discs can cause degenerative disc disease or
other disorders where the disc becomes thinner and allows the vertebrae
to move closer together or become misaligned. As a result, nerves may
become pinched, causing pain that radiates into other parts of the body,
or instability of the vertebrae may ensue.

[0004] One method for correcting disc-related disorders is to insert a
fusion cage between the vertebrae to act as a structural replacement for
the deteriorated disc. The fusion cage is typically a hollow metal device
usually made of titanium. Once inserted, the fusion cage maintains the
proper separation between the vertebrae to prevent nerves from being
pinched and provides structural stability to the spine. Also, the inside
of the cage is filled with bone graft material which eventually fuses
permanently with the adjacent vertebrae into a single unit.

[0005] The use of fusion cages for fusion and stabilization of vertebrae
in the spine is known in the prior art. U.S. Pat. No. 4,961,740 to Ray,
et al. entitled, "V-Thread Fusion Cage and Method of Fusing a Bone
Joint," discloses a fusion cage with a threaded outer surface, where the
crown of the thread is sharp and cuts into the bone. Perforations are
provided in valleys between adjacent turns of the thread. The cage can be
screwed into a threaded bore provided in the bone structure at the
surgical site and then packed with bone chips which promote fusion.

[0006] U.S. Pat. No. 5,015,247 to Michelson entitled, "Threaded Spinal
Implant," discloses a fusion implant comprising a cylindrical member
having a series of threads on the exterior of the cylindrical member for
engaging the vertebrae to maintain the implant in place and a plurality
of openings in the cylindrical surface.

[0007] U.S. Pat. No. 6,342,074 to Simpson entitled, "Anterior Lumbar
Underbody Fusion Implant and Method For Fusing Adjacent Vertebrae,"
discloses a one-piece spinal fusion implant comprising a hollow body
having an access passage for insertion of bone graft material into the
intervertebral space after the implant has been affixed to adjacent
vertebrae. The implant provides a pair of screw-receiving passages that
are oppositely inclined relative to a central plane. In one embodiment,
the screw-receiving passages enable the head of an orthopaedic screw to
be retained entirely within the access passage.

[0008] U.S. Pat. No. 5,885,287 to Bagby entitled, "Self-tapping Interbody
Bone Implant," discloses a bone joining implant with a rigid, implantable
base body having an outer surface with at least one bone bed engaging
portion configured for engaging between a pair of bone bodies to be
joined, wherein at least one spline is provided by the bone bed engaging
portion, the spline being constructed and arranged to extend outwardly of
the body and having an undercut portion.

[0009] U.S. Pat. No. 6,582,467 to Teitelbaum et al. entitled, "Expandable
Fusion Cage," discloses an expandable fusion cage where the surfaces of
the cage have multiple portions cut out of the metal to form sharp barbs.
As the cage is expanded, the sharp barbs protrude into the subcortical
bone of the vertebrae to secure the cage in place. The cage is filled
with bone or bone matrix material.

[0010] U.S. Pat. No. 5,800,550 to Sertich entitled, "Interbody Fusion
Cage," discloses a prosthetic device which includes an inert generally
rectangularly shaped support body adapted to be seated on hard end plates
of vertebrae. The support body has top and bottom faces. A first peg is
movably mounted in a first aperture located in the support body, and the
first aperture terminates at one of the top and bottom faces of the
support body. Further, the first peg projects away from the one of the
top and bottom faces and into an adjacent vertebra to secure the support
body in place relative to the vertebra.

[0011] U.S. Pat. No. 6,436,140 to Liu et al. entitled, "Expandable
Interbody Fusion Cage and Method for Insertion," discloses an expandable
hollow interbody fusion device, wherein the body is divided into a number
of branches connected to one another at a fixed end and separated at an
expandable end. The expandable cage may be inserted in its substantially
cylindrical form and may be expanded by movement of an expansion member
to establish lordosis of the spine. An expansion member interacts with
the interior surfaces of the device to maintain the cage in the expanded
condition and provide a large internal chamber for receiving bone
in-growth material.

[0012] These patents all disclose fusion cage devices that can be inserted
between vertebrae of the spine in an invasive surgical procedure. Such an
invasive surgical procedure requires a long recovery period.

SUMMARY OF THE INVENTION

[0013] The present invention is directed to a bone fusion device for
insertion between bones that are to be fused together, such as, for
example, the vertebrae of a spinal column. The bone fusion device
comprises at least one extendable tab and one or more tab extension
assemblies. Each tab extension assembly is able to be adjusted in order
to individually control the extension or contraction of a side of the tab
thereby enabling adjustment of the height and/or angle of the tab with
respect to the body of the bone fusion device. The bone fusion device is
in its most compact state when the tab is aligned with the body of the
device such that the tab lies within the exterior of the body of the
device. In this compact form, the bone fusion device is preferably
inserted between the vertebrae by using an arthroscopic procedure. After
the device has been positioned between the vertebrae, the tab is extended
using the extension assemblies such that the tab abuts the bottom surface
of the upper vertebrae. The angle of the tab with respect to the body of
the device is able to be adjusted such that it corresponds to the
vertebrae. Specifically, each extension assembly is able to be
individually adjusted such that the side controlled by each assembly is
raised or lowered until the desired tab angle is achieved. In this way,
the tab is advantageously positioned and angled to correspond to the
vertebrae to help brace the device until the bone has fused and to
provide a larger surface area to which the bones attach and fuse during a
healing period.

[0014] A first aspect of the present application is directed to a bone
fusion device for insertion into a desired location. The device comprises
a body having an interior cavity, a tab configured to fit within the
interior cavity and selectively move from a retracted position within
interior cavity of the body to an extended position extending out of the
body and a plurality of extension assemblies coupled to a different
portion of the tab and configured to move the different portions of the
tab between the retracted position and the extended position independent
of the remainder of the extension assemblies. In some embodiments, each
of the extension assemblies comprise a worm gear operably coupled between
a drive screw and a support jack such that rotation of the drive screw
rotates the worm gear which retracts or extends the support jack into or
out of the worm gear. In some embodiments, at least one of the drive
screws of the extension assemblies is accessible through a first lateral
side of the body and at least a second one of the drive screws is
accessible through a second lateral side of the body. In some
embodiments, the extension assemblies are pivotably coupled to the
different portions of the tab such that the tab is able to pivot about
the extension assembly. In some embodiments, the body has a bottom
surface and an upper surface, wherein the upper surface is angled with
respect to the bottom surface. In some embodiments, the device further
comprises one or more plugs, wherein the body and the tab comprise one or
more holes that extend from outside the device to the inner cavity and
are configured to be removably filled by the plugs. In some embodiments,
the plugs comprise bone material. In some embodiments, the tab comprises
one or more tangs positioned along the perimeter of the top surface of
the tab and fit within recesses in the top surface of the body when the
tab is in the retracted position. In some embodiments, one or more of the
tangs extend from the perimeter of the tab to the perimeter of the body.
In some embodiments, the device further comprises a support webbing
positioned within the inner cavity of the body between one or more walls
of the inner cavity and the exterior of the worm gears such that the
support webbing resists lateral movement of the worm gears with respect
to the walls of the inner cavity.

[0015] A second aspect of the present application is directed to a method
of implanting a bone fusion device into a desired location. The method
comprises inserting the bone fusion device in the desired location,
wherein the bone fusion device comprises a body having an interior
cavity, a tab configured to fit within the interior cavity and
selectively move from a retracted position within interior cavity of the
body to an extended position extending out of the body and a plurality of
extension assemblies coupled to a different portion of the tab and
configured to move the different portions of the tab between the
retracted position and the extended position independent of the remainder
of the extension assemblies and independently extending one or more of
the different portions of the tab from the retracted position within the
interior cavity to a position at least partially outside the interior
cavity by moving at least one of the extension assemblies. In some
embodiments, the method further comprises adjusting the amount which one
or more of the different portions of the tab are extended compared to the
remainder of the different portions of the tab such that the angle of the
tab with respect to the body is adjusted. In some embodiments, each of
the extension assemblies comprise a worm gear operably coupled between a
drive screw and a support jack such that rotation of the drive screw
rotates the worm gear which retracts or extends the support jack into or
out of the worm gear. In some embodiments, at least one of the drive
screws of the extension assemblies is accessible through a first lateral
side of the body and at least a second one of the drive screws is
accessible through a second lateral side of the body. In some
embodiments, the extension assemblies are pivotably coupled to the
different portions of the tab such that the tab is able to pivot about
the extension assembly. In some embodiments, the body has a bottom
surface and an upper surface, wherein the upper surface is angled with
respect to the bottom surface. In some embodiments, the method further
comprises removably filling one or more holes with one or more plugs,
wherein the body and the tab comprise the one or more holes, which extend
from outside the device to the inner cavity and are configured to be
removably filled by the plugs. In some embodiments, the plugs comprise
bone material. In some embodiments, the tab comprises one or more tangs
positioned along the perimeter of the top surface of the tab and fit
within recesses in the top surface of the body when the tab is in the
retracted position. In some embodiments, one or more of the tangs extend
from the perimeter of the tab to the perimeter of the body. In some
embodiments, the device further comprises a support webbing positioned
within the inner cavity of the body between one or more walls of the
inner cavity and the exterior of the worm gears such that the support
webbing resists lateral movement of the worm gears with respect to the
walls of the inner cavity. In some embodiments, the method further
comprises retracting the tab of the bone fusion device into the retracted
position before inserting the bone fusion device into the desired
location.

[0016] A third aspect of the present application is directed to a
distraction instrument for use with a bone fusion device. The distraction
instrument comprises a tubular body, a control rod positioned at least
partially within the tubular body, wherein the control rod comprises a
first end coupled with a handle and extending out a first side of the
tubular body and a second end including an engaging element and extending
out a second side of the tubular body and a head assembly comprising a
plurality of plates and operably coupled with engaging element of the
control rod such that manipulating the control rod with respect to the
head assembly causes the plates to separate. In some embodiments, the
head assembly is operably coupled with the engaging element such that
rotation of the control rod with respect to the head assembly causes the
plates to separate and rotation in the opposite direction causes the
plates to contract. In some embodiments, the head assembly further
comprises a jack mechanism coupled between the plates that effectuates
the separating and the contracting of the plates and is configured to fit
within one or more recesses within the plates when the plates are fully
contracted. In some embodiments, the instrument further comprises an
indicator positioned on the surface of the instrument, wherein the
indicator dynamically indicates the distance between the plates. In some
embodiments, the indicator indicates one or more values corresponding to
how much one or more controls of one or more bone fusion implant devices
must be rotated to extend one or more tabs of the devices such that the
devices have height equal to the distance between the plates. In some
embodiments, the instrument further comprises a force sensor coupled to
the head assembly, wherein the force sensor measures a level of force
resisting the separation of the plates. In some embodiments, the
indicator indicates the level of force measured by the force sensor. In
some embodiments, the head assembly is configured to stop the plates from
further separating once the level of force measured by the force sensor
equals a threshold level. In some embodiments, the instrument further
comprises a motor and a motor control coupled with the control rod,
wherein the motor control controls the operation of the motor and the
motor enables motorized manipulation of the control rod to separate the
plates.

[0017] A fourth aspect of the present application is directed to a method
of using a distraction instrument to measure the amount of space in a
desired location. The method comprises inserting the distraction
instrument in the desired location, wherein the distraction instrument
comprises a tubular body, a control rod positioned at least partially
within the tubular body, wherein the control rod comprises a first end
coupled with a handle and extending out a first side of the tubular body
and a second end including an engaging element and extending out a second
side of the tubular body and a head assembly comprising a plurality of
plates and operably coupled with engaging element of the control rod such
that moving the control rod with respect to the head assembly causes the
plates to separate and separating the plates until the plates reach
bounds of the desired location by manipulating the control rod with
respect to the head assembly. In some embodiments, the manipulating the
control rod comprises rotating the control rod with respect to the head
assembly wherein rotation in a first direction causes the plates to
separate and rotation in a second direction causes the plates to
contract. In some embodiments, the head assembly further comprises a jack
mechanism coupled between the plates that effectuates the separating and
the contracting of the plates and is configured to fit within one or more
recesses within the plates when the plates are fully contracted. In some
embodiments, the instrument further comprises an indicator positioned on
the surface of the instrument, wherein the indicator dynamically
indicates the distance between the plates. In some embodiments, the
indicator indicates one or more values corresponding to how much one or
more controls of one or more bone fusion implant devices must be rotated
to extend one or more tabs of the devices such that the devices have
height equal to the distance between the plates. In some embodiments, the
instrument further comprises a force sensor coupled to the head assembly,
wherein the force sensor measures a level of force resisting the
separation of the plates. In some embodiments, the indicator indicates
the level of force measured by the force sensor. In some embodiments, the
head assembly is configured to stop the plates from further separating
once the level of force measured by the force sensor equals a threshold
level. In some embodiments, the instrument further comprises a motor and
a motor control coupled with the control rod, wherein the motor control
controls the operation of the motor and the motor enables motorized
manipulation of the control rod to separate the plates.

[0018] A fifth aspect of the present application is directed to a bone
fusion device for insertion into a desired location. The device comprises
a body having an interior cavity, a tab configured to fit within the
interior cavity and selectively move from a retracted position within
interior cavity of the body to an extended position extending out of the
body, a plurality of extension assemblies coupled to a different portion
of the tab and configured to move the tab between the retracted position
and the extended position and a position locking mechanism operably
coupled with each of the plurality of extension assemblies and configured
to provide a plurality of locking positions that the plurality of
extension assemblies are biased to stay in by the position locking
mechanism. In some embodiments, the plurality of extension assemblies are
configured to move the different portions of the tab between the
retracted position and the extended position independent of the remainder
of the extension assemblies. In some embodiments, the position locking
mechanism comprises a dial operably coupled with one of the plurality of
extension assemblies such that when the one of the plurality of extension
assemblies is rotated the dial is also rotated. In some embodiments, the
position locking mechanism comprises one or more stops operably coupled
with the dial such that when the one of the plurality of extension
assemblies is in one of the locking positions the interface between the
dial and the stops provides a biasing force that resists the movement of
the one of the plurality of extension assemblies out of the one of the
locking positions.

BRIEF DESCRIPTION OF THE DRAWINGS

[0019] FIG. 1A illustrates an external perspective view of a bone fusion
device according to some embodiments.

[0020] FIG. 1B illustrates an internal perspective view of a bone fusion
device according to some embodiments.

[0021]FIG. 2 illustrates a perspective view of the components of the bone
fusion device according to some embodiments.

[0022]FIG. 3A illustrates a cross sectional view of the bone fusion
device with the tab retracted according to some embodiments.

[0023]FIG. 3B illustrates a cross sectional view of the bone fusion
device with the tab extended according to some embodiments.

[0024]FIG. 4 illustrates a flow chart of a method of operating the bone
fusion device according to some embodiments.

[0025]FIG. 5 illustrates the bone fusion device comprising one or more
bone plugs according to some embodiments.

[0026]FIG. 6A illustrates a frontal view of a bone fusion device
according to some embodiments.

[0027]FIG. 6B illustrates a side view of a bone fusion device according
to some embodiments.

[0028]FIG. 6c illustrates a top view of an elongated member inserted
within a canal of a bone fusion device according to some embodiments.

[0029]FIG. 6D illustrates a frontal and profile view of an elongated
member according to some embodiments.

[0030]FIG. 6E illustrates a front view of the bone fusion device having
one or more tangs according to some embodiments.

[0031]FIG. 6F illustrates a profile view of the bone fusion device having
one or more tangs according to some embodiments.

[0032]FIG. 6G illustrates a top view of the bone fusion device having one
or more tangs according to some embodiments.

[0033]FIG. 7 illustrates a flowchart directed to a method of using the
bone fusion system according to some embodiments.

[0034]FIG. 8A illustrates a top view of a bone fusion device according to
some embodiments.

[0035]FIG. 8B illustrates a top view of a bone fusion device according to
some embodiments.

[0036]FIG. 8c illustrates a top view of a bone fusion device according to
some embodiments.

[0037] FIG. 8D illustrates a top and perspective view of a bone fusion
device according to some embodiments.

[0038]FIG. 8E illustrates a top and perspective view of a bone fusion
device according to some embodiments.

[0039]FIG. 8F illustrates a top and perspective view of a bone fusion
device according to some embodiments.

[0040]FIG. 8G illustrates a perspective view of a bone fusion device
according to some embodiments.

[0041] FIG. 9 illustrates a cross sectional perspective view of a bone
fusion device having one or more angled drive screws according to some
embodiments.

[0042]FIG. 10 illustrates a flowchart directed to a method of using a
bone fusion device according to some embodiments.

[0043] FIG. 11 illustrates a flowchart directed to a method of using a
bone fusion device according to some embodiments.

[0044]FIG. 12 illustrates a perspective view of a distraction instrument
for measuring the space to be filled by a bone fusion device according to
some embodiments.

[0045] FIG. 13 illustrates a top cross sectional view of the distraction
body according to some embodiments.

[0046]FIG. 14 illustrates a perspective view of the components of the
retraction head of the retraction instrument according to some
embodiments.

[0047]FIG. 15A illustrates cross sectional view of the head of the
retraction instrument with the plates fully retracted according to some
embodiments.

[0048]FIG. 15B illustrates cross sectional view of the head of the
retraction instrument with the plates fully extended according to some
embodiments.

[0049]FIG. 16 illustrates a flow chart of a method of operating the
retraction instrument according to some embodiments.

[0050]FIG. 17A illustrates a top view of the bone fusion device
comprising a webbing according to some embodiments.

[0051]FIG. 17B illustrates a cross-sectional side view of the bone fusion
device comprising a webbing according to some embodiments.

[0052]FIG. 18A illustrates a perspective view of a bone fusion system
according to some embodiments.

[0053] FIG. 18B illustrates a perspective view of a bone fusion system
according to some embodiments.

[0054] FIG. 19 illustrates a perspective view of a bone grafting material
bag according to some embodiments.

[0055]FIG. 20 illustrates a flowchart directed to a method of using the
bone fusion system according to some embodiments.

[0056]FIG. 21A illustrates a bone fusion device with a tab configured to
have the maximum parallel distraction according to some embodiments.

[0057]FIG. 21B illustrates a bone fusion device with a tab configured to
have the maximum angle according to some embodiments.

[0058]FIG. 22 illustrates a bone fusion device having a position locking
mechanism according to some embodiments.

DETAILED DESCRIPTION

[0059] In the following description, numerous details and alternatives are
set forth for purpose of explanation. However, one of ordinary skill in
the art will realize that the invention can be practiced without the use
of these specific details. For instance, the figures and description
below often refer to the vertebral bones of a spinal column. However, one
of ordinary skill in the art will recognize that some embodiments of the
invention are practiced for the fusion of other bones, including broken
bones and/or joints. In other instances, well-known structures and
devices are shown in block diagram form in order not to obscure the
description of the invention with unnecessary detail. Further, although
the figures and description below refer to a bone fusion device having a
single tab and a pair of tab extension assemblies, it is understood that
the bone fusion device is able to comprise multiple tabs each having any
number of tab extension assemblies.

[0060] FIGS. 1A and 1B illustrate an external and internal perspective
view of a bone fusion device 100 according to some embodiments. As shown
in FIGS. 1A and 1B, the bone fusion device 100 comprises a body 102, at
least one tab 104 and a plurality of tab extension assemblies each
comprising a drive screw 106A, 106B, a gear 108A, 108B and a supporting
jack 110A, 110B. Alternatively, the device 100 is able to comprise a
single tab extension assembly. The front tab extension assembly comprises
a front drive screw 106A which is mechanically coupled to a front
supporting jack 110A via a front gear 108A, and the back tab extension
assembly comprises a rear drive screw 106B which is mechanically coupled
to a rear supporting jack 110B via a rear gear 108B. As a result, the
supporting jacks 110A, 110B are able to be individually and selectively
raised or lowered with respect to the gears 108A, 108B by rotating or
otherwise manipulating the corresponding drive screws 106A, 106B of the
extension assemblies. As shown in FIG. 1A, when combined with the body
102 and tab 104, the drive screws 106A, 106B are able to be positioned
within a pair of screw channels 204 of the body 102 (see FIG. 2) and the
supporting jacks 110A, 110B are able to couple with the jack holes 208 at
the front and rear of the tab 104. Accordingly, by accessing and
adjusting the drive screws 106A, 106B of the tab extension assemblies
through the screw channels 204 of the body 102, a user is able to not
only selectively extend and retract the tab 104 a desired distance from
the body 102, but also is able to adjust the angle of the tab 104 by
lowering or raising the sides of the tab 104 with respect to each other.
Alternatively, the tab extension assemblies are able to comprise other
components for selectively raising or lowering the tab 104 such as a
plurality of angled extending blocks that are able to be individually
controlled by drive screws such that they press against the tab 104 to
selectively extend/retract and adjust the angle of the tab 104.

[0061] The bone fusion device 100 is able to be constructed from a high
strength biocompatible material, such as titanium, which has the strength
to withstand forces in the spine that are generated by a patient's body
weight and daily movements. Alternatively, part or all of the bone fusion
device 100 is able to be constructed from one or more of the group
consisting of ceramics, high strength biocompatible material, a polymer
such as PEEK, PEKK and other polymeric materials, stainless steel,
titanium, titanium alloys such as nitinol and other biocompatible metals.
In some embodiments, the materials used to construct the bone fusion
device include using additives, such as carbon fibers for better
performance of the materials under various circumstances. The base
biocompatible material is often textured or coated with a porous material
conducive to the growth of new bone cells on the bone fusion device 100.

[0062] It should be noted that although FIGS. 1A and 1B illustrate a
single tab 104 having a pair of extension assemblies, the bone fusion
device 100 is able to comprise any number of tabs 104 each having any
number of extension assemblies. Further, although the extension
assemblies are shown as coupling to a front end and a back end of the tab
104, the assemblies are able to be coupled to any portion of the tab 104
such that the angle of the tab 104 in any plane is able to be adjusted
using the extension assemblies. In particular, for each tab extension
assembly coupled to a tab 104, another side or portion of the tab 104 is
able to be selectively raised or lowered with respect to the body 102
and/or other portions of the tab 104.

[0063]FIG. 2 illustrates a perspective view of the components of the bone
fusion device 100 according to some embodiments. As shown in FIG. 2, the
body 102 comprises a body cavity 202 for housing the other components in
a retracted state, one or more screw channels 204 for receiving the drive
screws 106A, 106B, and one or more body apertures 206 for providing
access to the cavity 202. Specifically, the body 102 houses the tab 104
and tab extension assemblies within the body cavity 202 such that when
the device 100 is in a retracted state the tab 104 and tab extension
assemblies are all positioned within the outer dimensions of the body
102. This enables the bone fusion device 100 to have the smallest profile
possible when in the tab 104 is retracted thereby minimizing the size of
the required surgical incision for the bone fusion surgery.

[0064] In some embodiments, the body 102 has a substantially rectangular
structure with an angled upper surface that aligns with the upper surface
of the tab 104 when the tab 104 is retracted. In some embodiments, the
upper surface of the body 102 is angled downward from front to back such
that the front wall is higher than the back wall. Alternatively, the
upper surface of the body 102 is able to be angled upward from front to
back and/or otherwise angled. Alternatively, the body 102 is able to
comprise other shapes such as shapes that substantially conform to the
shape of vertebrae. In some embodiments, the screw channels 204
positioned such that the screws 106A, 106B are accessible from the same
side of the body 102. Alternatively, the channels 204 are able to be
positioned such that the screws 106A, 106B are accessible from one or
more different sides of the body 102. The apertures 206 of the body 102
extend from the cavity 202 to the exterior of the body 102. As a result,
the apertures 206 permit bone graft material to be inserted into the
device 100 and to contact the vertebral bone before or after the device
100 has been inserted between the vertebrae of the patient. As used
herein, bone graft material is able to refer to materials, biologics or
other structures that promote osteoinduction and/or osteoconduction as
are well known in the art. For example, the bone graft material is able
to comprise, in combination or separately, one or more of autologous
bone, allograft bone, artificial bone paste, artificial bone putty,
osteoinduction material, osteoconduction material or other "scaffolding"
for bone to grow upon and to induce bone growth as are well known in the
art. The bone graft material and the surface texturing of the device 100
encourage the growth and fusion of bone from the neighboring vertebrae.
The fusion and healing process will result in the bone fusion device 100
aiding in the bridging of the bone between the two adjacent vertebral
bodies of the spine which eventually fuse together during the healing
period. Additionally, it is understood that although as shown in FIG. 2,
the body 102 comprises a single aperture 206 positioned on a rear
surface, the body 102 is able to comprise any number of apertures 206
positioned on any of the surfaces of the body 102.

[0065] In some embodiments, the body 102 of the bone fusion device 100
comprises one or more gripping channels (not shown) each having at least
one gripping aperture. In such embodiments, the gripping apertures are
able to receive the gripping fingers of a bone fusion device insertion
instrument such that the instrument cannot slip out of place during
operation. In particular, the gripping channels and insertion instrument
are able to be substantially similar in operation and structure to the
bone fusion device channels and bone fusion device insertion instrument
described in U.S. Provisional Application No. 61/521,681, filed Aug. 9,
2011 and entitled "BONE FUSION DEVICE, APPARATUS AND METHOD," which is
hereby incorporated by reference. As a result, an insertion instrument is
able to grip and insert the bone fusion device 100 while preventing or at
least minimizing the risk of the insertion instrument and/or bond fusion
device 100 slipping out of place. Indeed, this security is necessary to
ensure that the surgeon is able to precisely place and control the device
100 within a patient during surgery.

[0066] As shown in FIG. 2, the tab 104 comprises one or more tab apertures
210 and one or more jack holes 208 such that there is at least one jack
hole 208 for each jack 110A, 110B. Specifically, the jack holes 208 are
positioned and sized such that the ends of the jack heads 224 of the
jacks 110A, 110B are able to couple to the tab 104 by being positioned
within the jack holes 208. For example, in some embodiments a pair of
jack holes 208 are able to be positioned across from each other on the
tab 104 such that the holes 208 straddle each jack head 224 preventing
the jack 110A, 110B from separating from the tab 104. In some
embodiments, the jack holes 208 (and at least a portion of the profile of
the jack heads 224) are substantially circular such that when coupled to
the jacks 110A, 110B, the jacks 110A, 110B are able to rotate within the
jack holes 208 with respect to the tab 104. In particular, this
rotational coupling provides the advantage of enabling the angle of tab
104 with respect to the body 102 and/or extension assemblies to be
adjusted because the rotation of the jacks 110A, 110B within the holes
208 corresponds to the angle change of the tab 104 with respect to the
body 102 and/or assemblies. Alternatively, the jack holes 208 and jack
heads 224 are able to comprise ball joints or other shapes and/or
profiles that enable both coupling and rotation as are well known in the
art.

[0067] The tab 104 is shaped such that the tab 104 is able to fit within
the cavity 202 of the body 102. For example, in some embodiments the tab
104 is shaped such that its perimeter profile matches the perimeter of
the cavity 202 and/or such that the outwardly facing surface of the tab
104 is substantially flush with the frame 114 of the bone fusion device
100 when the tab 104 is in the retracted position. In some embodiments,
the upper surface of the tab 104 is angled downward from front to back
such that the front wall is higher than the back wall. Alternatively, the
upper surface of the tab 104 is able to be angled upward from front to
back and/or otherwise angled. Alternatively, the tab 104 is able to
comprise other shapes as are well known in the art. In some embodiments,
tabs 104 having upper surfaces of varying angles are able to be
interchanged within the bone fusion device 100. As a result, a user is
able to exchange the current tab 104 of a device 100 with a different tab
104 having a differently angled upper surface. This allows the same bone
fusion device 100 to be switched from having the maximum parallel
distraction 120 with a tab 104 with a parallel upper surface as shown in
FIG. 21A to the maximum angle 122 with a tab 104 having the maximum
angled upper surface as shown in FIG. 21B or angles in between. In some
embodiments, the outwardly facing surface of the tab 104 has sharp
serrated edges, protrusions, ridges or threads along the length of the
tab 104 for engaging the adjacent vertebrae. Further, it is understood
that although as shown in FIG. 2, the tab 104 comprises a single tab
aperture 210 positioned on an upper surface, the tab 104 is able to
comprise any number of tab apertures 210 positioned on any of the
surfaces of the tab 104.

[0068] As shown in FIG. 2, the drive screws 106A, 106B each comprise a
positioning aperture 214, a threaded portion 212 and a recessed portion
216, the gears 108A, 108B each comprise gear teeth 218 and interior
threading 220, and the jacks 110A, 110B each comprise a jack head 224,
exterior threading 222 and a bottom protrusion 226. Specifically, as
shown in FIG. 1B, the threaded portion 212 of the drive screws 106A, 106B
is positioned such that the threads align with the gear teeth 218 of one
of the gears 108A, 108B and the interior threading 220 of the gears 108A,
108B matches the exterior threading 222 of the jack heads 224 when the
jack heads 224 are positioned within the gears 108A, 108B. As a result,
when the drive screws 106A, 106B are rotated, the threaded portion 212
applies force to the gear teeth 218 rotating the interior threading 220
of the gears 108A, 108B. This rotation causes the interior threading to
apply force to the exterior threading 222 of the jacks 110A, 110B causing
the jacks 110A, 110B to extend out of or retract further within the gears
108A, 108B. In particular, if the screws 106A, 106B are rotated in a
first direction, the jacks 110A, 110B are extended out of the gears 108A,
108B until the bottom protrusion 226 reaches the interior threading 220
(see FIG. 3B). Conversely, if the screws 106A, 106B are rotated in an
opposite second direction, the jacks 110A, 110B are retracted further
within the gears 108A, 108B until the bottom of the jack heads 224 abut
the upper surface of the gears 108A, 108B (see FIG. 3A). Thus, when
coupled to the tab 104, by rotating the drive screws 106A, 106B, the tab
extension assemblies are able to selectively retract/extend and adjust
the angle of the tab 104 with respect to the body 102. Alternatively, one
or more of the drive screws 106A, 106B, gears 108A, 108B and/or jacks
110A, 110B are able to be mechanically coupled using other mechanically
coupling components as are well known in the art. For example, a
universal joint is able to be used instead of the threaded portion 212
and gear teeth 218 in order to translate the rotation of the drive screws
106A, 106B to the gears 108A 108B.

[0069] The positioning apertures 214 of the drive screws 106A, 106B are
positioned on the end of the screws 106A, 106B such that they are
accessible when the drive screws 106A, 106B are within the screw channels
204 of the body 102. As a result, a user is able to insert one or more
tool engaging members (not shown) into the positioning apertures 214 in
order to rotate the drive screws 106A, 106B. The structure of the
positioning apertures 214 is configured such that the structure enables
one or more engaging members of tools to rotate the drive screws 106A,
106B. For example, the positioning apertures 214 are able to match the
engaging members of allen wrenches, flat-head screw drivers, phillips
screw drivers and/or the engaging members of other types of tools as are
well known in the art. The recessed portions 216 of the drive screws
106A, 106B are positioned such that they are adjacent to and/or surround
the gear 108A, 108B that is not mechanically coupled to the threaded
portion 212 of that drive screw 106A, 106B. As a result, the recessed
portions 216 are able to help hold the gears 108A, 108B and screws 106A,
106B in place with respect to each other while not translating the
rotation of the screws 106A, 106B to the gear 108A, 108B of the other tab
extension assembly. Alternatively, the recessed portions 216 are able to
be omitted. For example, the recessed portions 216 are able to be omitted
and the threaded portion 212 is able to protrude out from the cylindrical
body of the screws 106A, 106B in order to maintain mechanical coupling
with the gear teeth 218. In some embodiment, the body 102 further
comprises one or more tool channels (not shown) that selectively couple
with a tool when the engaging member of the tool is coupled with one or
more of the positioning apertures 214. As a result, the tool and its
engaging member is able to be prevented from slipping out of the
positioning apertures 214 which is able to cause harm to a patient during
an insertion procedure.

[0070] FIGS. 3A and 3B illustrate cross sectional view of the bone fusion
device 100 with the tab 104 fully retracted and fully extended,
respectively, according to some embodiments. As shown in FIG. 3A, when
the device is in the retracted position, the jacks 110A, 110B are fully
retracted within the gears 108A, 108B and the outward facing surface of
the tab 106 is substantially flush with the upper surface of the body
102. While in this position, the bone fusion device 100 creates the
smallest profile possible and thus is able to be surgically inserted
between two vertebrae of a patient with a minimally invasive procedure.
As shown in FIG. 3B, once in position, the surgeon is able to use one or
more tools (not shown) to rotate the drive screws 106A, 106B of the tab
extension assemblies until the tab 104 has been raised to a desired
height by the jacks 110A, 110B. Further, the surgeon is able to
individually raise or lower the jacks 110A, 110B such that the tab 104 is
rotated and the upper angle of the tab 104 with respect to the body 102
is adjusted. Accordingly, the bone fusion device 100 provides the
advantage of enabling not only the tab height to be adjusted to a desired
level, but also that the tab angle to be adjusted to a desired degree in
order to best correspond to the vertebrae thereby increasing the
stability of the bone fusion and the success of the surgery.

[0071]FIG. 5 illustrates the bone fusion device 100 comprising one or
more bone plugs 500 according to some embodiments. As shown in FIG. 5,
the bone plugs 500 comprise a plug body 502 having at least one desired
profile or perimeter 504. Specifically, the perimeter 504 of the plug
body 502 is sized such that the plug 500 fits within one or more of the
tab 104 or body 102 apertures 210, 206. As a result, one or more bone
plugs 500 are able to be used to fill one or more of the apertures of the
bone fusion device 100. This creates the benefit of reducing the amount
of bone graft material that needs to be inserted into the cavity 202 of
the bone fusion device 100. In some embodiments, the bone fusion device
100 comprises at least one bone plug 500 for each aperture within the
body 102 and/or the tab 104. Alternatively, at least one of the apertures
within the body 102 and/or the tab 104 are able to remain "unplugged"
such that bone graft material is able to be injected into the device 100
through the unplugged apertures. In some embodiments, the bone plugs 500
are sized such that the perimeter 504 will contact the inner surface of
the apertures 210, 206 when the bone plug 500 is inserted into the
aperture such that friction from the contact will hold the plug 500 in
place. In some embodiments, the perimeter 504 is able to be sized
slightly larger than the inner surface of the apertures 210, 206 such
that upon insertion into an aperture either the aperture or the plug 500
flexes, wherein the resistance to the flexing provides a force holding
the plug or plugs 500 in place within the aperture. Alternatively, the
plugs 500 are able to have differently shaped perimeters 504 as are well
known in the art.

[0072] In some embodiments, the body 502 of one or more of the plugs 500
has a thickness greater than the thickness of the apertures 206, 210 such
that the plugs 500 are able to protrude into and/or out of the bone
fusion device 100 when positioned within one of the apertures 206, 210.
Alternatively, the body 502 is able to be less thick and/or be positioned
such that body 502 aligns with the surface of the bone fusion device 100
when inserted in an aperture 206, 210. In some embodiments, the body 502
of the plugs 500 comprises bone. Alternatively, the body 502 is able to
comprise one or more materials selected from the group consisting of
bone, bone graft material capable of retaining a desired shape, bone-like
substances known to aid in the fusion process and other biocompatible
materials as are well known in the art. In some embodiments, the one or
more of the plugs 500 are flexible. Alternatively, the plugs 500 are able
to be inflexible or rigid. Although the bone plugs 500 are described in
reference to the bone fusion device 100, it is understood that they are
able to be sized in order to fill the apertures of other types of bone
fusion devices.

[0073]FIG. 4 illustrates a flow chart of a method of operating the bone
fusion device 100 according to some embodiments. A user rotates one or
more of the drive screws 106A, 106B of the tab extension assemblies until
the tab 104 is in a fully retracted position at the step 402. The user
inserts the bone fusion device 100 into the desired position within the
patient at the step 404. In some embodiments, the desired position
comprises between or adjacent to one or more vertebrae. In some
embodiments, the bone fusion device 100 is inserted anteriorly.
Alternatively, the bone fusion device 100 is able to be inserted
posteriorly, laterally, far lateral, extra lateral, extreme lateral,
transforaminaly, or other directions as are well known in the art. The
user rotates one or more of the drive screws 106A, 106B of the tab
extension assemblies until the tab 104 is extended to a desired height at
the step 406. In some embodiments, the desired height comprises the
height required such that the tab 104 abuts the vertebrae. The user
rotates one or more of the drive screws 106A, 106B of the tab extension
assemblies until the tab 104 is rotated to a desired angle at the step
408. In some embodiments, the device 100 comprises a single tab extension
assembly such that only the drive screw or screws associated with the
single tab extension assembly need to be rotated. In some embodiments,
the desired angle comprises the angle required to cause the outward
facing surface of the tab 104 to substantially match the angle of the
surface of the adjacent vertebrae. In some embodiments, the angle of the
surface of the tab 104 is able to be adjusted before and/or during the
extension of the tab 104 to the desired height. As a result, the tab 104
and the remainder of the bone fusion device 100 is able to exert a
satisfactory force between the bone fusion device and the bones to be
fused. At that point the bone fusion device 100 is able to remain in
place. Thereafter, in some embodiments, material, such as autograft
material, for fusing the bones together is able to be inserted through
the apertures 206, 210 of the bone fusion device 100 to promote healing.
Alternatively, the insertion of the material is able to be omitted or
occur before insertion of the bone fusion device 100. In some
embodiments, the method is able to comprise a plurality of bone fusion
devices 100 that are each able to be used as described herein. In such
embodiments, the plurality of bone fusion devices 100 are able to be
inserted and/or adjusted together or separately. Alternatively, a single
bone fusion device 100 is able to be used. For example, a single bone
fusion device 100 is able to be used for a cervical surgery operation.
Therefore, the bone fusion device 100 provides the advantage of a small
incision and minimally invasive (arthroscopic) surgical procedure which
advantageously promotes health and rapid recovery by the patient.
Preferably, bone growth occurs around the bone fusion device and
particularly at the location of the extended tab, such that the bone
fusion device is further secured by the bone growth, which further
promotes a superior, robust bone fusion result.

[0074] FIGS. 6A-C illustrate a front, side and top view of a bone fusion
device 600 having one or more canals 621 according to some embodiments.
The bone fusion device 600 shown in FIGS. 6A-C is substantially similar
to the bone fusion device 100 except for the differences described
herein. In particular, the bone fusion device 600 comprises a body 614
having one or more canals 621 and one or more tabs 630. In some
embodiments, the canals 621 are positioned along the sides of the body
614 and a sized such that the canals 621 are able to receive or house a
portion or all of one or more elongated members 623 (see FIG. 6D).
Alternatively, one or more of the canals 621 are able to be positioned
within other portions of the body 614 including different angles and
orientations in one or all axises of the bone fusion device 600.
Alternatively, one or more of the canals 621 are able to be positioned
within one or more of the tabs 630. In some embodiments, the canals 621
extend from a central area of the body 614 to the front or back side of
the body 614 such that an elongated member 623 is able to enter the
canals 621 from the front or back side of the body 614 (and/or the side
of the body 614). Alternatively, one or more of the canals 621 extend
along the entire bone fusion device 600 from the front side to the back
side of the body 614 (or vice versa), such that an elongated member 623
is able to enter the canals 621 from both or either the front or back
side of the body 614. Alternatively, one or more of the canals 621 are
able to be housed entirely within an inner portion of the body 614 such
that the canals 621 breach neither the front nor the back side of the
body 614 and the elongated members 623 are only able to enter the canals
621 from the side of the body 614.

[0075]FIG. 6c illustrates a top view of an elongated member 623 inserted
within a canal 621 of the bone fusion device 600 according to some
embodiments. As shown in FIG. 6c, the elongated member 623 is curved and
extends from the front of the body 614 and canal 621 to a central portion
of the body 614. Alternatively, the elongated members 623 are able to be
configured such that the members 623 extend to the front, back, or other
portions of the body 614. In some embodiments, one or more of the
elongated member 621 are able to extend out of the canals 621 into the
central cavity of the body 614 and/or outside of the body 614. For
example, the members 623 are able to be curved or otherwise shaped such
that the members 623 enter a desired portion of the body 614 while not
extending out of the side of the body 614 more than a desired distance
(e.g. 1 mm). In some embodiments, the desired portion of the body 614 in
which the members 623 are positioned comprise between the front or back
side of the body 614. Alternatively, the members 623 are able to be
configured such that the members 623 are able to remain entirely within
the canals 621 and/or cavity of the body 614. Additionally, it should be
noted that one or more of the components of the bone fusion device 600 is
able to be incorporated into the other bone fusion devices described
herein.

[0076]FIG. 6D illustrates a frontal and profile view of an elongated
member 623 according to some embodiments. As shown in FIG. 6D, the
elongated member 623 comprises a body 625 and one or more apertures 627.
The body 625 is sized such that the member 623 is able to partially or
wholly fit within the canals 621. In some embodiments, the body 625 is
able to be tubular such that material, such as autograft material, is
able to be inserted into the body 625 via the apertures 627.
Alternatively, the body 625 is able to be partially or wholly solid,
wherein if the body 625 is wholly solid the apertures 627 are able to be
omitted. Alternatively, the body 625 is able to comprise other solid or
hollow shapes as are well known in the art. As shown in FIG. 6D, the body
625 of the elongated member 623 is substantially straight. Alternatively,
the body 625 is able to comprise one or more curves and/or corners as are
well known in the art. For example, as shown in FIG. 6c, the body 625 is
able to be curved such that the member 623 is able to curve from the
canal 621 into the cavity of the body 614 of the bone fusion device 600.
In some embodiments, the elongated member 623 is able to be bendable such
that body 625 is able to be bended to a desired shape by a user and the
body 625 will retain the desired shape. In some embodiments, the body 625
is filled with one or more of calcium triphosphate, hydroxyapatite or
other materials that are constituents of bone or promote bone growth as
are well known in the art. In some embodiments, the body 625 is able to
comprise materials that are constituents of bone or promote bone growth
as are well known in the art. Alternatively, the body 625 is able to
comprise the same or similar materials to that of the bone fusion device
600. As a result, the bone fusion device 600 and the elongated members
623 are able to be used to position bone grafting promotive material
along the device 600 after the bone fusion device 600 has been positioned
into place within a patient. This enables the bone fusion device 600 to
ensure that the bone fusion material is not pushed out of place during
the extension of the tabs 630 or other portions of the procedure.

[0077] FIGS. 6E-G illustrate a front, profile and top view of the bone
fusion device 2400 having one or more tangs 2406 according to some
embodiments. The bone fusion device 2400 shown in FIGS. 6E-G is
substantially similar to the bone fusion device 100 except for the
differences described herein. In particular, the bone fusion device 2400
comprises a body 2402 having one or more tang recesses 2408 and one or
more tabs 2404 having one or more tangs 2406. The tangs 2406 extend from
one or more of the tabs 2404 and increase the surface area of the tabs
2404 thereby promoting bone growth and aiding the fusion process. The
tang recesses 2408 are sized and positioned to receive or house each of
the tangs 2406 when the tabs 2404 are retracted into the body 2402 in
order to maintain the minimal size of the device 2400 when in the
retracted position. In some embodiments, each tang 2406 has a separate
corresponding tang recess 2408. Alternatively, one or more of the tang
recesses 2408 are able to house a plurality of tangs 2406. In some
embodiments, the tangs 2406 are positioned around the top perimeter of
one or more of the tabs 2404. Alternatively, the tangs 2406 are able to
be positioned elsewhere on one or more of the tabs 2404 such that the
tangs 2406 are able to increase the surface area of the tabs 2404. In
some embodiments, one or more of the tangs 2406 are able to extend beyond
the perimeter of the body 2402. In such embodiments, when the tab 2404 is
retracted within the body 2402, a portion of the extended tangs 2406
would be housed within the tang recesses 2408 and a portion of the tangs
2406 would protrude out of the tang recesses 2408 beyond the perimeter of
the body 2402. Although the tangs 2406 and tang recesses 2408 are
described in reference to the bone fusion device 2400, it is understood
that they are able to be incorporated into the other bone fusion devices
described herein.

[0078] A method of using the bone fusion device 600 according to some
embodiments is illustrated by the flow chart in FIG. 7. A user selects
one or more elongated members 623 based on the shape and size of the
elongated members 623 at the step 702. Alternatively, the user selects
one or more elongated members 623 and bends them into a desired shape and
size. The user fills one or more of the selected elongated members 623
with bone grafting material at the step 704. The user positions the bone
fusion device 600 within the patient at the step 706. The user inserts
the one or more elongated members 623 within and/or outside the canals
621 and/or body 614 of the bone fusion device 600 at the step 708.
Alternatively, one or more of the elongated members 623 are able to be
positioned within and/or outside of the canals 621 before or during the
positioning of the bone fusion device 600 within the patient. Thus, the
method of using the bone fusion system provides the advantage of allowing
the bone grafting material to be packed into the elongated members 623
and positioned after the positioning of the bone fusion device 600 within
the patient. As a result, the bone fusion device 600 is able to prevent
the elongated members 623 from being moved during the positioning of the
bone fusion device within the patient thereby keeping the bone grafting
material in the desired position and/or shape with respect to the
adjacent bones and bone fusion device 600 such that quicker and stronger
bone fusion is promoted speeding up the healing process. In some
embodiments, one or more of the steps of the above method are able to be
omitted or combined with the other methods described herein.

[0079] FIGS. 8A-8G illustrate top and perspective views of a bone fusion
device 800 according to some embodiments. Although one or more of the
components discussed above are omitted, the bone fusion devices 800 shown
in FIGS. 8A-8G are substantially similar to the bone fusion device 100
except for the differences described herein. As shown in FIGS. 8A-8G, the
bone fusion device 800 comprises drive screws 808 one or more tabs 830
and a body/frame 814. Specifically, the body 814 comprises an oval shaped
(FIG. 8A), kidney shaped (FIG. 8B), round shaped (FIG. 8c), rectangular
shaped (FIG. 8D), banana shaped (FIG. 8E) or otherwise shaped (FIG. 8F)
top/bottom profile such that the shape of the top/bottom profile of the
body 814 is substantially similar to the shape of the horizontal profile
of one or more vertebrae. Alternatively, the top/bottom profile of the
body 814 is able to comprise one or more other shapes that substantially
match bones that are to be fused to the bone fusion device 800.
Alternatively, the top profile of the tabs 830 are able to be shaped as
described herein, wherein the body 814 remains the standard shape as
described above. In some embodiments, the top profile of the tabs 830 are
shaped substantially similar to the top/bottom profile of the body 814.
For example, as shown in FIGS. 8D-8F, the tabs 830 have rounded edges to
match the perimeter of the frames 814. Alternatively, the top profile of
the tabs 830 is able to comprise other shapes as are well known in the
art. In some embodiments, the top profile shapes of the body 814 are
between 15 and 25 mm along the anterior/posterior axis and between 20 and
45 mm along the lateral axis. Alternatively, other dimensions are
envisioned. For example, for bone fusion devices designed for cervical
spinal bones, the body 814 is able to be less than 15 mm along the
anterior/posterior axis and less then 20 mm along the lateral axis.
Alternatively, the body 814 is able to be 55 mm or longer along the
lateral axis (typically for extreme lateral lumbar interbody fusion). In
some embodiments, the body 814 and/or tab 830 have an angled upper
surface such that the angle of the bone fusion device 800 matches the
angle between the vertebrae. In some embodiments, the angle is equal to
15 degrees. Alternatively, other angles are able to be utilized. In some
embodiments, as shown in FIG. 8G, the drive screws 808 are able to be
non-parallel with the elongated top dimension/axis 815 of the body 814.

[0080] As a result, the bone fusion device 800 provides the advantage of
substantially matching the horizontal profiles of the bones to be fused,
thereby increasing the strength and efficiency of the fusion process.
Further, the profile shapes provide the advantage of enabling a user to
select a bone fusion device 800 with a top profile shape whose
orientation matches the insertion orientation of the operation.
Additionally, the angles at which the drive screws 808 are oriented with
respect to the elongated axis 815 of the body 814 is able to be selected
to match the angle of access provided by a desired operation. As a
result, the bone fusion device 800 does not need to be turned to be in
the proper orientation between the bones of the patient whether the
procedure is anterior, posterior, lateral, far-lateral or transforaminal
lumbar interbody fusion. Moreover, the upper surface angles provide the
advantage of enabling a user to select a bone fusion device 800 with a
body 814 and/or tab 830 angle that matches the angle between the target
vertebrae.

[0081] FIG. 9 illustrates a cross sectional perspective view of a bone
fusion device 900 having one or more angled drive screws according to
some embodiments. The bone fusion device 900 shown in FIG. 9 is
substantially similar to the bone fusion device 100 except for the
differences described herein. Specifically, as shown in FIG. 9, the bone
fusion device 900 comprises a body 902 housing one or more drive screws
904, 904' and one or more gears 906. At least one of the drive screws
904' is able to be angled with respect to the elongated dimension of the
body 902 while still operable coupled with one of the gears 906.
Alternatively, a plurality or all of the drive screws 904, 904' are able
to be angled or non-parallel with respect to the elongated dimension of
the body 902. As a result, a user is able to control the extension,
retraction and angle adjustment of the tab (not shown) by rotating the
gears 906 using the drive screws 904, 904'. In some embodiments, the
angled drive screws 904' are positioned such that the drive screw 904 is
substantially perpendicular to the elongated dimension of the body 902.
Alternatively, the angled drive screws 904' are able to be positioned
such that they each form any angle with the elongated dimension of the
body 902 while still operably coupled to one of the gears 906. Thus, the
bone fusion device 900 provides the advantage of allowing the tab to be
extended/retracted and/or the angle of the tab adjusted from angles other
than parallel to the elongated dimension of the body, which is critical
in procedures where the device 900 is to be inserted from varying angles
such as, for example, anterior lumbar interbody fusion, lateral lumbar
interbody fusion or transforaminal lumbar interbody fusion. Additionally,
the differences to the bone fusion device 900 described in FIG. 9 are
able to be incorporated with and/or replace components of each of the
other bone fusion devices described herein.

[0082] A method of using the bone fusion device 800 according to some
embodiments is illustrated by the flow chart in FIG. 10. A user selects
the body angle and/or top profile shape of a bone fusion device 800 based
on a type of lumbar interbody fusion to be performed at the step 1002. In
some embodiments, the user selects an elongated oval shape body 814 based
on the type being extreme lateral lumbar interbody fusion. Alternatively,
the user selects a kidney or rounded shape body 814 based on the type
being anterior lumber interbody fusion. In some embodiments, the user
selects the shape of the top profile of the body 814 of a bone fusion
device 800 based on a horizontal profile of the bone or bones to be fused
to the device. For example, a bone fusion device is able to be selected
because the device 800 has a top profile shape that substantially matches
the shape of the horizontal profile of a cervical spinal bone or bones to
be fused with. The user inserts the selected bone fusion device 800 in
between the desired bones according to the type of lumbar interbody
fusion to be performed at the step 1004. In some embodiments, the bone
fusion device 600 is able to be positioned offset from the center of the
adjacent bones and/or discs. Thus, the method of using the bone fusion
device 600 provides the advantage of enabling a user to select a device
800 with desired dimensions of angle and/or top profile based on the type
of procedure thereby increasing the effectiveness of the procedure.
Additionally, it should be noted that one or more of the steps of the
above method are able to be omitted or combined with the other methods
described herein.

[0083] A method of using the bone fusion device 900 according to some
embodiments is illustrated by the flow chart in FIG. 11. A user selects a
bone fusion device 900 having one or more drive screws 904, 904' at a
desired angle relative to the elongated dimension of the body 902 of the
device 900 based on a type of lumbar interbody fusion to be performed at
the step 1102. In some embodiments, the user selects angled drive screws
904' that are substantially parallel to the elongated dimension of the
body 902 based on the type being anterior lumbar interbody fusion. In
some embodiments, the user selects a bone fusion device 900 having angled
drive screws 904' at a desired angle relative to the elongated dimension
of the body 902 based on the shape of the top profile of the body 902 of
a bone fusion device 900 and the type of lumbar interbody fusion to be
performed. The user inserts the selected bone fusion device 900 in
between the desired bones according to the type of lumbar interbody
fusion to be performed at the step 1104. Thus, the method of using the
bone fusion device 900 provides the advantage of enabling a user to
select a bone fusion device 900 having angled drive screws 904' that form
a desired angle with the elongated dimension of the body 902 of the bone
fusion device 900 based on the type of procedure thereby increasing the
effectiveness of the procedure. In some embodiments, one or more of the
steps of the above method are able to be omitted or combined with the
other methods described herein.

[0084]FIG. 12 illustrates a perspective view of a distraction instrument
1200 for measuring the space to be filled by a bone fusion device
according to some embodiments. As shown in FIG. 12, the distraction
instrument 1200 comprises a distraction body 1202 and a distraction head
1202 operably coupled together. FIG. 13 illustrates a top cross sectional
view of the distraction body 1202 according to some embodiments. As shown
in FIG. 13, the distraction body 1202 comprises a handle 1302, a engaging
element 1304 and a guide element 1306. The handle 1302 is coupled with
the engaging element 1304 which is positioned within the guide element
1306 such that a user is able to rotate, push and/or pull the handle 1302
in order to rotate, extend and/or retract the engaging element 1304
within or further out of the guide element 1306. In some embodiments, the
handle 1302 and/or guide element 1306 comprise one or more gripping
ridges enabling a user to rotate or otherwise move the handle 1302 with
respect to the guide element 1306 without slipping. In some embodiments,
the instrument 1200 is able to comprise an electric motor and control
interface (not shown) such that the movement of the handle 1302 is able
to be effectuated by a user controlling the operation of the electric
motor via the control interface. In some embodiments, the guide element
1306 comprises one or more a stop pins 1310 that couple to the stop
apertures 1417 of the rear fitting 1414 of the rear jack assembly 1404
(see FIG. 14). When coupled within the stop apertures 1417, the stop pins
1310 are able to prevent the distraction head 1202 from rotating with the
engaging element 1304 as well as keeping the rear fitting 1414 of the
rear jack assembly 1404 abut the end of the guide element 1306. In some
embodiments, the engaging element 1304 comprises a threaded portion 1312
positioned along the end of the engaging element 1304 such that the
threaded portion 1312 is able to operably coupling with the threads 1418
of the front fitting 1415 of the front jack assembly 1406 (see FIG. 14).
As a result, when the engaging element 1304 is rotated, the threaded
portion 1312 is able to engage the threads 1418 of the front fitting 1415
causing the front fitting 1415 to slide toward or away from the rear
fitting 1414. Alternatively, the threaded portion 1312 and the threads
1418 are able to be omitted and the end of the engaging element 1304 is
able to be coupled to the front fitting 1415 such that when the engaging
element 1304 is pulled into or pushed out of the guide element 1306 the
coupling causes the front fitting 1415 to also slide toward or away from
the rear fitting 1414. Alternatively, the threaded portion 1312 is a
female thread such that when the engaging element 1304 is rotated, the
threading 1312 causes the engaging element 1304 to retract into the guide
element 1306 and the front fitting 1415 to slide toward the rear fitting
1414. As a result, the engaging element 1304 does not protrude out of the
front fitting 1415 during the expanding or contracting of the plates
1402. In such embodiments, the threading 1312, male or female is able to
be positioned in other places along the engaging element 1304 and
complimenting threading is able to be positioned, for example, within the
conduit 1416 of the rear fitting 1414 or within the end of the guide
element 1306.

[0085] In some embodiments, one or more of the handle 1302, engaging
element 1304 and/or the guide element 1306 comprise one or more
indicators 1308 that indicate values corresponding to the current
separation between the plates 1402 of the head 1204 (see FIG. 14). In
some embodiments, the indicators 1308 comprise first markings on the
visually exposed surface of the engaging element 1304 and/or handle 1302
that move relative to corresponding second markings on the guide element
1302 when the engaging element 1304 is rotated or otherwise moved. As a
result, based on the alignment of the first and second markings the
current separation between the plates 1402 of the head 1204 is able to be
determined. Alternatively, the indicators 1308 are able to comprise a
digital or analog readout/display that indicates the current level of
distraction of the instrument 1200. In some embodiments, the motion of
the handle 1302 is effectuated by an electrical motor and the indicators
1308 are able to include the control interface for controlling the
operation of the electrical motor. Alternatively, other types of
indicating elements 1308 corresponding to the current separation of the
plates 1402 are able to be used as are well known in the art.

[0086] In some embodiments, the indicators 1308 indicate a number of
revolutions or rotations that the positioning element of a bone fusion
device will require in order to extend the tabs to the height indicated
by the separation of the plates 1402. For example, in some embodiments
the a user is able to input or the instrument 1200 is able to be
pre-programmed with the type of bone fusion device to be used and based
on this data, the indicators 1308 are able to indicate the number of
rotations/revolutions that the positioning element of a bone fusion
device will require in order to extend the tabs to the height indicated
by the separation of the plates 1402. In some embodiments, based on the
determined current separation of the plates 1402, the indicators 1308 are
able to indicate a recommended size and/or type of bone fusion device to
be used for filling the measured space. As a result, the distraction
instrument 1200 provides the advantage of indicating the best type/size
of bone fusion device to use and/or the exact amount of rotation needed
to a user of a bone fusion device such that the user does not overextend
the tabs of the bone fusion device.

[0087] In some embodiments, the instrument 1200 comprises a force
measurement component (not shown) and/or the indicators 1308 indicate the
amount of force on the plates 1402 that is resisting the
expansion/distraction of the plates 1402. In such embodiments, the
distraction instrument 1200 is able to be configured to prevent the user
from further extending/distracting the plates 1402 when a predefined
and/or adjustable force threshold value is detected by the force
measurement component. For example, if the distraction is effectuated by
an electronically controlled motor the distraction system is able to be
configured to automatically stop when the force threshold value is
detected. Alternatively, the force measurement component is able to be
implemented mechanically such that the components of the instrument 1200
that effectuate the distraction of the plates 1402 prevent further
distraction when a predetermined and/or adjustable amount of resistance
is present. As a result, the distraction instrument 1200 provides the
benefit of enabling a user to manually stop, automatically stopping
and/or preventing the user for continuing to distract the plates 1402
when the force measurement component and/or indicators 1308 indicate that
a predetermined amount of expansion resistant force is detected on the
plates 1402. Thus, the distraction instrument 1200 prevents over
distraction that which results in inaccurate measurements and possible
injury.

[0088]FIG. 14 illustrates a perspective view of the components of the
retraction head 1204 of the retraction instrument 1200 according to some
embodiments. As shown in FIG. 14, the retraction head 1204 comprises a
pair of retraction plates 1402 coupled together by a rear jack assembly
1404 and a front jack assembly 1406. The rear and front jack assemblies
1404, 1405 each comprise a rear/front fitting 1414, 1415 having a fitting
conduit 1416 and coupled to a plurality of legs 1422 via one or more
fitting pins 1420. Specifically, the plurality of legs 1422 each have a
leg pin 1424 and a leg aperture 1419, wherein the leg apertures 1419 are
configured to slide onto a pair of fitting protrusions 1421 such that the
legs 1422 are able to pivot/rotate about the fitting protrusions 1421 and
are prevented from sliding off the protrusions 1421 by the fitting pins
1420. As shown in FIG. 14, two fitting protrusions are each rotatably
coupled to a pair of legs 1422. Alternatively, more of less fitting
protrusions 1421 are able to be rotatably coupled to more or less legs
1422. Alternatively, the protrusions 1421 and/or fitting pins 1420 are
able to be omitted and the legs 1422 are able to be rotatably coupled to
the fittings 1414, 1415 via other coupling mechanisms as are well known
in the art.

[0089] In some embodiments, the conduit 1416 of the rear fitting 1414 is
bare whereas the conduit 1416 of the front fitting 1415 has an inner
threading 1418 that is operably coupled to the threaded portion 1312 of
the engaging element 1304 when the engaging element 1304 is positioned
within the conduits 1416 of the retraction head 1204. As a result, the
engaging element 1304 is able to freely move independent of the rear
fitting 1414, but causes the front fitting 1415 to move toward or away
from the rear fitting 1414 along the engaging element 1304 when rotated.
Alternatively, the threading 1418 of the conduit 1416 of the front
fitting 1415 is able to be omitted and the engaging element 1304 is able
to be otherwise coupled to the front fitting 1415 such that when the
engaging element 1304 is pulled into or pushed out of the guide element
1306 the coupling causes the front fitting 1415 to correspondingly slide
toward or away from the rear fitting 1414. In some embodiments, the rear
fitting 1414 comprises one or more stop apertures 1417 that couple with
the stop pins 1310 in order to prevent the distraction head 1202 from
rotating with the engaging element 1304 and to keep the rear fitting 1414
of the rear jack assembly 1404 in contact with the end of the guide
element 1306. Alternatively, the stop pins 1310 and stop apertures 1417
are able to be omitted and the rear fitting 1414 is able to be coupled to
the guide element 1306 via other coupling mechanisms as are well known in
the art.

[0090] The retraction plates 1402 each comprise one or more leg pin
apertures 1408, a pair of fitting cavities 1410 and a plate channel 1412.
The leg pin apertures 1408 are configured to rotationally couple to the
leg pins 1424 such that the plates 1402 are coupled together via the
front and rear jack assemblies 1404, 1406. Specifically, when the legs
1422 are caused to rotate about the protrusions 1421 (due to movement of
the engaging element 1304), the legs 1422 also rotate within the leg pin
apertures 1408 about the leg pins 1424 causing the plates 1402 to
selectively move apart or come together. When the plates 1402 are
positioned together the fitting cavities 1410 and plate channels 1412 of
the upper plate 1402 align with the fitting cavities 1410 and plate
channel 1412 of the lower plate 1402. As a result, the height of the
retraction head 1204 in the retracted position is minimized because the
rear and front fittings 1414, 1415 are able to fit within the aligned
fitting cavities 1410 and the engaging element 1412 is able to fit within
the aligned plate channels 1412. This provides the advantage of
minimizing the size of the required surgical incision for the bone fusion
surgery measurement operation.

[0091] FIGS. 15A and 15B illustrate cross sectional view of the head 1204
of the retraction instrument 1200 with the plates 1402 fully retracted
and fully extended, respectively, according to some embodiments. As shown
in FIG. 15A, when the retraction instrument 1200 is in the retracted
position, the plates 1402 are in contact such that the fittings 1414,
1415 are all or partially housed within/between the plates 1402. While in
this position, the retraction instrument 1200 creates the smallest
profile possible and thus is able to be surgically inserted between two
vertebrae of a patient with a minimally invasive procedure. As shown in
FIG. 15B, once in position, the user is able to rotate or otherwise move
the engaging element 1304 within the guide element 1306 and head 1204 by
manipulating the handle 1302. This manipulation causes the front fitting
1415 to selectively move closer to the rear fitting 1414 and
correspondingly the plates 1402 to move away from each other until the
desired measurement has been made or the maximum height has been reached
due to the front fitting 1415 contacting the rear fitting 1414 along the
engaging element 1304. The, user is then able to retract the plates 1402
back together for removal using the opposite rotation and/or opposite
other movement of the engaging element 1304 via the handle 1302.
Accordingly, the retraction instrument 1200 provides the advantage of a
minimized retracted profile that enables a surgeon to measure the size of
the space needed to be filled by a bone fusion device or other device
while minimizing the surgical incision required to take the measurement.

[0092]FIG. 16 illustrates a flow chart of a method of operating the
retraction instrument 1200 according to some embodiments. A user rotates
or otherwise moves the engaging element 1304 until the head 1204 is in a
fully retracted position at the step 1602. The user inserts the
retraction instrument 1200 into the desired position within the patient
at the step 1604. In some embodiments, the desired position comprises
between or adjacent to one or more vertebrae. In some embodiments, the
retraction instrument 1200 is inserted anteriorly. Alternatively, the
retraction instrument 1200 is able to be inserted posteriorly, lateral,
far-lateral or transforaminaly. The user rotates or otherwise moves the
engaging element 1304 until the head 1204 is extended to a desired height
at the step 1606. In some embodiments, the desired height comprises the
height required such that the lower and upper plates 1402 abut the
vertebrae. The indicators 1308 indicate the amount of separation between
the plates 1402 at the step 1608. In some embodiments, the indicators
1308 indicate a type and/or size of bone fusion device to utilize to fill
the measured space. In some embodiments, the indicators 1308 indicate a
number of rotations/revolutions that the positioning element of a bone
fusion device will require in order to extend the tabs to the height
indicated by the amount of separation of the plates 1402. In some
embodiments, the indicators 1308 indicate the current amount of expansion
resisting force on the plates 1402. In some embodiments, the desired
height comprises the height or separation of the lower and upper plates
1402 when the indicators 1308 indicate the plates 1402 are experiencing a
predetermined expansion resisting force threshold value. The user
retracts and removes the retraction device 1200 from the patient at the
step 1610. In some embodiments, the user then inserts the a bone fusion
device into the desired position and extends the tabs such that the bone
fusion device fills the indicated height. In some embodiments, the user
extends the tabs such that the bone fusion device fills the indicated
height by rotating the positioning element of the bone fusion device a
number of times indicated by the indicators 1308. In some embodiments,
the bone fusion device inserted was selected based on size and/or type of
bone fusion device indicated by the indicators 1308. Therefore, the
retraction instrument 1200 provides the advantage of determining the size
of the space within the patient while only requiring a small incision and
minimally invasive (arthroscopic) surgical procedure which advantageously
promotes health and rapid recovery by the patient. Further, by
determining the size of the space to be filled, the instrument 1200
provides the advantage of enabling the user to select a bone fusion
device of the appropriate size to fit within the space and enables the
user to pre-configure the tabs of the bone fusion device to near the
height required to fill the space such that minimal extension of the tabs
is required when the device is in place within the patient.

[0093] FIGS. 17A and 17B illustrate a top and cross-sectional side view of
the bone fusion device 100 comprising a webbing 1700 according to some
embodiments. As shown in FIGS. 17A and 17B, the webbing 1700 comprises a
webbing body 1702 having at least one webbing aperture 1704 for each jack
110A, 110B and one or more bracing members 1706. Specifically, the
webbing apertures 1704 are sized such that the jacks 110A, 110B fit
snugly within the webbing apertures 1704 and the bracing members 1706 are
sized such that they are able to brace the webbing 1700 against the inner
walls of the body 102 when the jacks 110A, 110B are within the webbing
apertures 1704. As a result, the webbing 1700 is able to support the
jacks 110A, 110B such that the jacks 110A, 110B are restricted from
moving along the plane of the webbing 1700 (e.g. laterally). In some
embodiments, as shown in FIG. 17B, the webbing 1700 is able to be
positioned substantially parallel or orthogonal to the bottom of the
device body 102. Alternatively, the webbing 1700 is able to be positioned
at an angle 1708 in any direction with respect to the plane formed by the
bottom of the device body 102. In some embodiments, the webbing body 1702
is substantially planar. Alternatively, the webbing body 1702 is able to
have bends and/or curves in order to better fit within the body 102
and/or support the jacks 110A, 110B. Alternatively, the webbing body 1702
is able to extend to the bottom of the inner surface of the body 102 such
that the webbing body 1702 is seated on the bottom of the inner surface
of the body 102. In such embodiments, the upper surface of the webbing
body 1702 is able to be substantially planar or have bends and/or curves
in order to better fit within the body 102 and/or support the jacks 110A,
110B. In some embodiments, the bone fusion device 100 is able to comprise
a plurality of webbing bodies 1700 positioned at the same or different
angles in order to provide increased support to the jacks 110A, 110B. In
some embodiments, the webbing body 1702 comprises elastic materials such
that as the jacks 110A, 110B move and apply force to the webbing body
1702, the webbing body 1702 resists the movement along the plane of the
webbing 1700 as the movement increases and springs the jacks 110A, 110B
back in place as the force subsides. Alternatively, the webbing body 1702
is able to comprise inelastic or rigid materials such that the jacks
110A, 110B are substantially prevented from moving along the plane of the
webbing 1700. Alternatively, the webbing body 1702 is able to comprise
both elastic and inelastic material such that the elastic portions allow
some movement of the jacks 110A, 110B, but the inelastic portions limit
the extent of this movement. Although the webbing 1700 is shown in FIG.
17A as comprising six bracing members 1706, it is understood that any
number of bracing members 1706 are able to be used and each is able to be
of varying sizes and positioned along any portion of the perimeter of the
webbing 1700. For example, the webbing body 1702 is able to comprise a
single bracing member 1706 that forms the entire perimeter of the webbing
1700 and abuts the inner perimeter of the device body 102. Also, although
the webbing 1700 is described in reference to the bone fusion device 100,
it is understood that the webbing 1700 is able to be used in conjunction
with the other bone fusion devices described herein.

[0094] FIGS. 18A and 18B illustrate perspective views of a bone fusion
system 2100 according to some embodiments. The bone fusion devices 2102
shown in FIGS. 18A and 18B are substantially similar to the bone fusion
device 100 except for the differences described herein. The bone fusion
system 2100 comprises one or more bone fusion devices 2102 and one or
more bone grafting material bags 2104. As shown in FIG. 18A, the bone
grafting material bags 2104 are able to be positioned and/or coupled
within the bone fusion device 2102. Additionally, as shown in FIG. 18B,
the material bags 2104 are also able to be positioned or coupled outside
of the bone fusion device 2102. FIG. 19 illustrates a perspective view of
a bone grafting material bag 2104 according to some embodiments. As shown
in FIG. 19, the material bag 2104 comprises a mesh frame 2202, one or
more support bars 2204, at least one opening 2206 for filling the bag
2104 with bone graft material, one or more bag fasteners 2208 and one or
more bag coupling elements 2210. In some embodiments, the support bars
2204, bag fasteners 2208 and/or bag coupling elements 2210 are able to be
omitted. The support bars 2204 couple to the mesh frame 2202 in order to
help the mesh frame 2202 maintain its shape. In some embodiments, the
shape of the mesh frame 2202 is a cylinder (as shown in FIGS. 18A and
19). Alternatively, the shape of the mesh frame 2202 is able to be a
"half-moon" prism (as shown in FIG. 18B) or other shapes capable of
holding a volume of bone grafting material as are well known in the art.
In some embodiments, the support bars 2204 comprise polymeric materials
such that the support bars 2204 are able to maintain the shape of the
material bag 2104. Alternatively, the support bars 2204 are able to
comprise other materials capable of supporting the shape of the bag 2104
as are well known in the art.

[0095] The opening 2206 enables bone grating material to be packed into
the bone grafting material bag 2104 and is able to vary in size based on
the size of the mesh frame 2202. The bag fastener 2208 is positioned on
the mesh frame 2202 such that the bag fastener 2208 is able to releasably
close or fasten the opening 2206 shut such that bone grafting material
within the material bag 2104 is unable to escape through the opening
2206. In some embodiments, the bag fastener 2208 comprises a hoop around
the opening 2206 and a cinch cord to selectively cinch closed the opening
2206. Alternatively, the bag fasteners 2208 are able to comprise other
types of fastening means as are well known in the art. In some
embodiments, the material bags 2104 are able to comprise a plurality of
openings 2206 and at least one bag fastener 2208 for each opening. The
bag coupling element 2210 enables the material bag 2104 to be coupled to
one or more bone fusion devices 2102 and/or other material bags 2104. As
a result, the bone fusion system 2100 provides the advantage of enabling
the user to physically pack a material bag 2104 full of bone grafting
material in order to maximize the amount of grafting material provided to
the bones. Further, the system 2100 provides the advantage of keeping the
bone grafting material in the desired location and shape with respect to
the bones to be fused to and/or the position of the bone fusion device
2102 thereby increasing the efficiency of the bone growth and/or healing
process. Additionally, it should be noted that one or more of the
components of the bone fusion system 2100 are able to be incorporated
into the bone fusion system 1000 described above in reference to FIGS.
10-12 and vice versa.

[0096] A method of using the bone fusion system 2100 according to some
embodiments is illustrated by the flow chart in FIG. 20. A user selects
one or more bone grafting material bags 2104 based on the shape and size
of the material bags 2104 at the step 2302. The user fills one or more of
the selected bone grafting material bags 2104 with bone grafting material
at the step 2304. In some embodiments, the material bag 2104 is filled
with the bone grafting material with an implement resembling a "caulking
gun." Alternatively, the material bag 2104 is able to be filled by a
packing element and/or other methods of packing bone grafting material as
are well known in the art. The user couples the one or more material bags
2104 within and/or outside the bone fusion device 2102 at the step 2306.
The user moves the bone fusion system 2100 into the desired position
within the patient at the step 2308. In some embodiments, the material
bags 2104 are positioned such that they abut the bones adjacent the bone
and/or disc to be replaced. Thus, the method of using the bone fusion
system 2100 provides the advantage of allowing the bone grafting material
to be packed into the material bags and keeping the bone grafting
material in the desired position and/or shape with respect to the
adjacent bones and bone fusion device 2102 such that quicker and stronger
bone fusion is promoted speeding up the healing process. Additionally, it
should be noted that one or more of the steps of the above method are
able to be omitted or combined with the other methods described herein.

[0097]FIG. 22 illustrates a bone fusion device 2500 having a position
locking mechanism 2502 according to some embodiments. The bone fusion
device 2500 shown in FIG. 25 is substantially similar to the bone fusion
device 100 except for the differences described herein. It is noted that
the tab 104 of the bone fusion device 2500 have been omitted from FIG. 22
for the sake of clarity. As shown in FIG. 22, the body 102 comprises one
or more locking apertures 2502 configured to receive one or more position
locking mechanisms 2503, wherein each of the position locking mechanisms
2503 comprise one or more dials 2504 and one or more stoppers 2506. In
some embodiments, the device 2500 comprises a locking aperture 2502 and a
position locking mechanism 2503 for each tab extension assembly or drive
screw 106A, 106B. Alternatively, one or more of the tab extension
assemblies or drive screws 106A, 106B are able to have more or less than
one locking aperture 2502 and/or position locking mechanism 2503.

[0098] The dial 2504 is configured to rotatably fit within the locking
apertures 2502 and comprises a dial aperture 2512 and one or more dimples
2510 along the edge or perimeter of the dial 2504. The dial aperture 2512
is able to be sized or otherwise configured to receive an end of one of
the drive screws 106A, 106B such that if a drive screw 106A, 106B is
within the dial aperture 2512, the end of the drive screw 106A, 106B will
cause the dial 2504 to rotate along with the drive screw 106A, 106B. In
some embodiments, the drive screw 106A, 106B causes the dial 2504 to
rotate by directly physically contacting the dial aperture 2512.
Alternatively, the drive screw 106A, 106B is able to cause the dial 2504
to rotate via indirect contact. The one or more dimples 2510 are able to
be configured to receive one or more bumps 2508 of the stoppers 2506. In
particular, the dimples 2510 are able to have concave dimensions that
substantially match convex dimensions of the bumps 2508. The stoppers
2506 are able to be configured to fit within the locking apertures 2502
adjacent to the dial 2504 and comprise one or more bumps 2508. The
stoppers 2506, dials 2504 and apertures 2502 are configured such that
when within the locking apertures 2502, the stoppers 2506 are adjacent or
in contact with the dial 2504 and the bumps 2508 of the stoppers 2506
snap or spring fit within the dimples 2510 of the dial 2504 when a dimple
2510 and a bump 2508 are aligned. Additionally, when a dimple 2510 and a
bump 2508 are not aligned, the bump 2508 is compressed against the
dimple-less edge of the dial 2504 and primed to spring or decompress into
a dimple 2510 when alignment is achieved.

[0099] In some embodiments, the dial 2504 is held in place within the
locking apertures 2502 by force applied by the bumps 2508 of the stoppers
2506. Alternatively, the dial 2504 is able to be otherwise coupled or
uncoupled within the locking apertures 2502 by one or more fastening
elements as are well known in the art. In some embodiments, the stoppers
2506 are held in place within the locking apertures 2502 by place holders
2507. In particular, the place holders 2507 are able to be tensioned
and/or compressed by the wall of the locking apertures 2502 when the
stoppers 2506 are inserted into the locking apertures 2502 and thus
provide a spring force against the walls of the locking apertures 2502 to
try and relieve that tensioning/compression. Accordingly, the spring
force holds the stoppers 2506 within the locking apertures 2502.
Alternatively, one or more of the stoppers 2506 are able to be otherwise
coupled or uncoupled within the locking apertures 2502 by one or more
fastening elements as are well known in the art. Although as shown in
FIG. 22, the device 2500 comprises one side of the body 102 including two
position locking mechanisms 2503, wherein the position locking mechanisms
2503 comprise a single dial 2504 having sixteen dimples 2510 and two
stoppers 2506, it is understood that any of the sides of the body 102 are
able to include one or more position locking mechanisms 2503 and the
position locking mechanisms 2503 are able to include any number of dials
2504 having any number of dimples 2510 coupled to any number of stoppers
2506.

[0100] In operation, as the drive screws 106A, 106B are rotated to extend
or retract sides of the tab 104, the dial 2504 is rotated along with the
drive screws 106A, 106B and the bumps 2508 compress and decompress into
and out of the dimples 2510 as they move in an out of alignment with the
bumps 2508. As a result, each point during the rotation of the drive
screws 106A, 106B that results in an alignment of a bump 2508 and a
dimple 2510 serves as a demarcated degree of rotation and/or degree of
extension/retraction of the associated side of the tab 104. In this way,
the position locking mechanism 2503 provides the advantage of enabling a
user to rotate the drive screws 106A, 106B and thereby extend the sides
of the tab 104 to predetermined rotation/extension amounts and/or by
predetermined rotation/extension intervals represented by the spacing and
number of dimple 2510 and bump 2508 alignment points. For example, the
position and/or number of dimples 2510 and/or bumps 2508 of the position
locking mechanism 2503 is able to be adjusted to adjust the number and/or
position of the alignment points and therefore the number and/or position
of plate extension points. Thus, the position locking mechanism 2503 of
the bodiless bone fusion device 2500 is able to be tuned to different
size devices 2500 based on the number of extension increments needed and
the desired extension distance interval between each of the increments.
In some embodiments, the increments are configured to be constant.
Alternatively, the increments are able to be configured to decrease in
size as the sides of the tab 104 approach their maximum extension level.
Alternatively, other increment profiles are able to be used as are well
known in the art. Further, the compression of the bumps 2508 and their
resistance thereto during rotation of the drive screws 106A, 106B between
alignment points provides a slipping resistance force the resists
unintended rotation of the drive screws 106A, 106B out of an alignment
point. As a result, the position locking mechanism 2503 provides the
advantage of reducing the chance of the drive screws 106A, 106B
unintentionally rotating and/or the sides of the tab 104 unintentionally
extending or retracting.

[0101] Thus, the bone fusion device, system and method described herein
has numerous advantages. First, the bone fusion device, system and method
provide the advantage of substantially matching the device or tab top
surface profiles with the horizontal profiles of the bones to be fused,
thereby increasing the strength and efficiency of the fusion process. As
a result, the bone fusion device does not need to be turned to be in the
proper orientation between the bones of the patient whether the procedure
is anterior, posterior, lateral or transforaminal lumbar interbody
fusion. Second, the bone fusion device, system and method provide the
advantage of allowing the body to be extended from angles other than
parallel to one or more of the drive screws, which is critical in
procedures where the device is to be inserted from varying angles. Third,
the extension measurement instrument provides the advantage of enabling a
user to accurately measure the size of the space to be filled by the bone
fusion device thereby allowing the correct bone fusion device to be
selected, while also having a minimal profile such that the incision
required is minimized. Further, the bone fusion device, system and method
provides the advantage of enabling each side of the tab to be
individually adjusted such that the side controlled by each assembly is
raised or lowered until the desired tab angle is achieved. In this way,
the tab is advantageously positioned and angled to correspond to the
vertebrae to help brace the device until the bone has fused and to
provide a larger surface area to which the bones attach and fuse during a
healing period. Moreover, the bone fusion device, system and method
provides the advantage of enabling the user to physically pack a material
bag full of bone grafting material in order to maximize the amount of
grafting material provided to the bones, as well as providing the
advantage of keeping the bone grafting material in the desired location
and shape with respect to the bones to be fused to and/or the position of
the bone fusion device thereby increasing the efficiency of the bone
growth and/or healing process. Additionally, the position locking
mechanism provides the advantage of reducing the chance of the drive
screws unintentionally rotating and/or the sides of the tab
unintentionally extending or retracting. Finally, the bone fusion device,
system and method provides the advantage of allowing the bone grafting
material to be packed into the material bags and keeping the bone
grafting material in the desired position and/or shape with respect to
the adjacent bones.

[0102] The present invention has been described in terms of specific
embodiments incorporating details to facilitate the understanding of
principles of construction and operation of the invention. Such reference
herein to specific embodiments and details thereof is not intended to
limit the scope of the claims appended hereto. It will be apparent to
those skilled in the art that modification may be made in the embodiments
chosen for illustration without departing from the spirit and scope of
the invention.